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Change in drug regimen offers new hope in advanced breast cancer

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Change in drug regimen offers new hope in advanced breast cancer

A study co-authored by a Loyola researcher and published in the New England Journal of Medicine is offering new hope to women with advanced breast cancer.
The study found that combing two drugs that normally are each given as single agents significantly extended the lives of women with metastatic breast cancer. Kathy Albain, MD, a breast cancer specialist at Loyola University Medical Center, is among the main authors of the study.
The study found that women who initially took the drugs anastrozole and fulvestrant at the same time together lived more than six months longer than women who took anastrozole alone, with fulvestrant given later when the disease progressed.
“This study is the first to show that combination hormonal therapy alone without chemotherapy improves survival in advanced breast cancer,” Albain said. “This most likely will change the standard of care for how we treat these patients.”
First author is Rita Mehta, MD, of the University of California at Irvine.
Anastrozole (brand name, Arimidex®) is a pill that is taken daily. It is in a class of medications called aromatase inhibitors. It works by decreasing the amount of estrogen the body makes. (Estrogen fuels breast cancer.) Fulvestrant (brand name Faslodex®) is given by injection. It binds to estrogen receptors, thereby blocking the effect estrogen has on cancer cells.
The study included 707 postmenopausal women who had metastatic breast cancer that was hormone-receptor-positive. About half the women were randomly assigned to receive the standard regimen: treat first with anastrozole, and after the disease progresses, switch to fulvestrant. The other half were randomly assigned to receive anastrozole and fulvestrant in combination.
Women who received the standard regimen survived a median of 41.3 months. Women who received the two drugs in combination survived a median of 47.7 months.
Among women who received the standard regimen, it took a median of 13.5 months for the disease to progress. Among those who received the drugs in combination, it took 15 months before the disease progressed.
The combination treatment produced even greater benefits among women who had not previously taken tamoxifen.
Side effects generally were similar in both treatment groups, although only the combination group experienced the most severe side effects (one stroke and two pulmonary embolisms).
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Loyola University Health System: http://www.luhs.org

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Artificial butter flavoring ingredient linked to key Alzheimer’s disease process

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Artificial butter flavoring ingredient linked to key Alzheimer’s disease process

A new study raises concern about chronic exposure of workers in industry to a food flavoring ingredient used to produce the distinctive buttery flavor and aroma of microwave popcorn, margarines, snack foods, candy, baked goods, pet foods and other products. It found evidence that the ingredient, diacetyl (DA), intensifies the damaging effects of an abnormal brain protein linked to Alzheimer’s disease. The study appears in ACS’ journal Chemical Research in Toxicology.

Robert Vince and colleagues Swati More and Ashish Vartak explain that DA has been the focus of much research recently because it is linked to respiratory and other problems in workers at microwave popcorn and food-flavoring factories. DA gives microwave popcorn its distinctive buttery taste and aroma. DA also forms naturally in fermented beverages such as beer, and gives some chardonnay wines a buttery taste. Vince’s team realized that DA has an architecture similar to a substance that makes beta-amyloid proteins clump together in the brain — clumping being a hallmark of Alzheimer’s disease. So they tested whether DA also could clump those proteins.

DA did increase the level of beta-amyloid clumping. At real-world occupational exposure levels, DA also enhanced beta-amyloid’s toxic effects on nerve cells growing in the laboratory. Other lab experiments showed that DA easily penetrated the so-called “blood-brain barrier,” which keeps many harmful substances from entering the brain. DA also stopped a protective protein called glyoxalase I from safeguarding nerve cells. “In light of the chronic exposure of industry workers to DA, this study raises the troubling possibility of long-term neurological toxicity mediated by DA,” say the researchers.

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American Chemical Society: http://www.acs.org

Thanks to American Chemical Society for this article.

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Liver cancer cells stop making glucose as they become cancerous

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Liver cancer cells stop making glucose as they become cancerous

As liver cancer develops, tumor cells lose the ability to produce and release glucose into the bloodstream, a key function of healthy liver cells for maintaining needed blood-sugar levels.

As liver cancer develops, tumor cells lose the ability to produce and release glucose into the bloodstream, a key function of healthy liver cells for maintaining needed blood-sugar levels.

The findings come from a study by scientists at The Ohio State Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).

The loss of this type of glucose production, a process called gluconeogenesis, is caused by the over-expression of a molecule called microRNA-23a. The change might aid cancer-cell growth and proliferation by helping to maintain high levels of glycolysis under conditions of drastically reduced mitochondrial respiration, also known as the Warburg effect.

The findings suggest that suppressing miR-23a might reverse this process and offer a new treatment for hepatocellular carcinoma (HCC), the most common form of liver cancer.

The research is published in the journal Hepatology.

“This study identifies an important mechanism that severely blocks glucose production and its release from the liver as liver cells transform into cancer cells,” says principal investigator Dr. Samson Jacob, professor of molecular and cellular biochemistry and William and Joan Davis Professor in Cancer Research, Division of Hematology and Oncology at Ohio State and co-leader of the OSUCCC – James Experimental Therapeutics Program. “It is conceivable that delivery of an anti-miR23a to the tumor site could reverse this.”

For this study, Jacob and his colleagues used an animal model that develops diet-induced HCC, along with primary-tumor samples from patients and HCC cell lines. The mouse model mimics different stages of human hepatocarcinogenesis. Key findings include:

  • Levels of enzymes in the gluconeogenesis pathway were drastically reduced, along with transcription factors involved in the expression of the genes encoding those enzymes.
  • miR-23a expression was significantly up-regulated in the animal model and in primary human HCC.
  • miR-23a suppresses the enzyme glucose-6-phosphatase and the transcription factor PGC-1a, two important components of the gluconeogenesis pathway.
  • Interleukin-6 and Stat-3 signaling cause the upregulation of miR-23a.

“Based on our data,” Jacob says, “we conclude that gluconeogenesis is severely compromised in HCC by IL6-Stat3-mediated activation of miR-23a, which directly targets and suppresses glucose-6-phosphatase and PGC-1a, leading to decreased glucose production in HCC.”

Jacob notes that since glucose-6-phosphatase is also essential for liver cells to convert glycogen (the storage form of glucose) to glucose, suppression of this enzyme can block all pathways leading to glucose production by the liver.

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Ohio State University Medical Center: http://medicalcenter.osu.edu/Pages/index.aspx

Thanks to Ohio State University Medical Center for this article

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Bay Area Leads New Ranking of US Eco-Friendly Cities

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Bay Area Leads New Ranking of US Eco-Friendly Cities

There’s a new survey of the greenest US cities out, ranking them on per-capita availability of eco-friendly services, as well as the premium charged by some green businesses. The very top results aren’t all that surprising, but some of the top ten are, both in which cities are included and which aren’t.

According to Thumbtack, a site self-described as “where you can easily hire local help,” ranked US cities based on availability of solar panel installation, bicycle repair, chemical-free house cleaning, organic catering, electronics recycling, chemical-free pest control, chemical-free carpet cleaning, sustainable interior design, green architects, and home energy audits.

Based on that criteria here are the top 10 eco-friendliest cities in the nation:

  1. San Francisco
  2. Oakland
  3. San Jose
  4. Las Vegas
  5. Raleigh, NC
  6. Columbus, OH
  7. Seattle

    8. Kansas City, MO

  8. Denver
  9. San Diego

 

And the full rankings:

© Thumbtack

Some of the perhaps counter-intuitive results of the survey Thumbtack is highlighting include: 1) The fact that in terms of the availability of bike repair versus auto repair Virginia Beach, Sacramento, and Charlotte NC take the top three spots; and, 2) Las Vegas leads the nation, by a wide margin, in the per capita availability of green architectural services.

As or the premium paid for green services (adjusted for regional price differences), Thumbtack found that green house cleaning costs 20% more than non-green cleaning, green architects charge 14% more for their services (outside of an increased cost due to materials), and green landscaping services charge 11% more than their chemical-spraying brethren.

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How do Genetics Impact Behavior and Personality

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How do Genetics Impact Behavior and Personality

Genes are units of genetic information that mostly contain a building plan for a single protein. They are made of a sequence of DNA, our genetic material, and they sit on the DNA molecule like beads on a string.

What are genes?

The entire genetic material of an organism with a nucleus in its cells is distributed over several DNA molecules that are tightly packed with protecting proteins. These structures are called chromosomes. There are areas in the chromosomes that do not contain genes. These are important for controlling the expression of the genes and other functions.

How do genes work?

A gene contains the information necessary to build a specific protein. This information is stored in the sequence of the building blocks of the DNA molecule the four bases Adenosine, Cytosine, Guanine, and Thymine or short A, C, G, and T. To build a protein according to the instructions in the gene, a RNA-copy of the DNA is made and transported form the cell’s nucleus to the main cell body. Specific enzymes can read the information on the RNA and translate it into the correct sequence of amino acids, the building blocks of proteins. There are about 20 different amino acids available and the information for one amino acid is contained in a sequence of three bases on the DNA. 

How do genes impact behavior and personality?

How can a sequence of bases in the DNA that encodes a sequence of amino acids influence possibly our behavior and personality? The step from the working of a single gene to such complex features as personality and behavior is huge. However, if genetic information can determine how such complicated features like the eye of vertebrate develop, it is not too fantastic to imagine that it can also influence personality and behavior.

How exactly this happens is to date not fully understood. However, there are correlations between the physical development of the brain dependent on e.g. gender that have a strong influence on behavior. The amount of expression of certain messenger molecules called neurotransmitters in the brain can also have a large impact on behavior and can even lead to such diseases as depression or schizophrenia.

The expression of neurotransmitters and also of receptors for them is controlled by the product of certain genes and it is hypothesized that genetic polymorphisms in the expression levels can predispose people for alcohol and drug addictions and other disorders. Personality traits are even more complex than predispositions for mental disorders and we are still at the beginning of the understanding how genes can influence these.

How can the heritability of personality traits and behavior be measured?

How do we know at all that genes have an impact on personality and behavior i.e. how is heritability of personality and behavior measured? The contribution of genetics to behavior and personality in laboratory animal can be measured easily, since in this setting the breeding (genetics) and the environment are easily controlled.

For humans studies this is not possible. Researchers therefore resort to large and complicated family studies. Twin studies are very popular in this context. Some studies e.g. compare identical twin pairs that have been brought up separated form each other to the general population. Identical twins share all their genes, but the environment is different in this context. Other studies compare identical twins to fraternal twins who all share the same family environment, but the fraternal twins share only half of their genes. Looking at adoptive siblings, who share the environment, but no genes compared to biological siblings who share half of their genes and the environment, can also be helpful.

In meta-analysis of studies that looked at the Eysenck Personality Questionnaire (EPQ) dimensions (Neuroticism, Extraversion, and Psychoticism) it was found that the results for identical twins had a correlation of 0.468. A correlation of 1 would mean that the answers were 100% identical. Fraternal twins had only a correlation of 0.166, similar to other first-degree relative who had a correlation of 0.150. Second-degree relatives had a correlation of 0.073 and adoptive family members had only 0.030. This shows that there is a string genetic component to these personality traits, but environmental influences do also exists, otherwise the correlation between identical twin should be very close to 1. 

What is the nature versus nurture debate?

“Nature vs. nurture” is the tag line for the old question whether behavior and personality traits are most influenced by genetics (“nature”), or by the environment (“nurture”). Most scientists nowadays agree that to put this question this way is overly simplistic. Genetics might e.g. lead a certain person to seek a certain environment that than in turn influences the behavior and personality of this person. On the other hand, environmental stimuli can influence the expression levels of certain genes, so that the environment can contribute to the influence genetics has on the individual. This principle is best understood for genetic diseases that depending on the environment become apparent or not despite the fact that the individual has the gene for this disease. But it also is true for personality traits. It is therefore not helpful to think that there is a strict segregation between environmental influences and genetics.

 

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9 Scientists Receive a New Physics Prize

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9 Scientists Receive a New Physics Prize

Physicists are rarely wealthy or famous, but a new prize rewarding research at the field’s cutting edges has made nine of them instant multimillionaires.

Simon Dawson/Bloomberg News

Yuri Milner

The nine are recipients of the Fundamental Physics Prize, established by Yuri Milner, a Russian physics student who dropped out of graduate school in 1989 and later earned billions investing in Internet companies like Facebook and Groupon.

“It knocked me off my feet,” said Alan H. Guth, a professor of physics at the Massachusetts Institute of Technology who was among the winners. He came up with the idea of cosmic inflation, that there was a period of extremely rapid expansion in the first instant of the universe.

When he was told of the $3 million prize, he assumed that the money would be shared among the winners. Not so: Instead, each of this year’s nine recipients will receive $3 million, the most lucrative academic prize in the world. TheNobel Prize currently comes with an award of $1.2 million, usually split by two or three people. The Templeton Prize, which honors contributions to understanding spiritual dimensions of life, has been the largest monetary award given to an individual, $1.7 million this year.

The $3 million has already appeared in Dr. Guth’s bank account, one that had had a balance of $200. “Suddenly, it said, $3,000,200,” he said. “The bank charged a $12 wire transfer fee, but that was easily affordable.”

Mr. Milner said that he wanted to recognize advances in delving into the deepest mysteries of physics and the universe. “This intellectual quest to understand the universe really defines us as human beings,” he said.

Four of the physicists work at the Institute for Advanced Study in Princeton, N.J.: Nima Arkani-Hamed, Juan Maldacena, Nathan Seiberg and Edward Witten. They work on theories trying to tie together the basic particles and forces of the universe, particularly with a mathematical machinery known as string theory.

The other winners are Andrei Linde, a physicist at Stanford who also worked on cosmic inflation; Alexei Kitaev, a professor of physics at the California Institute of Technology who works on quantum computers; Maxim Kontsevich, a mathematician at the Institute of Advanced Scientific Studies outside Paris whose abstract mathematical findings proved useful to physicists unraveling string theory; and Ashoke Sen, a string theorist at Harish-Chandra Research Institute in India.

Mr. Milner personally selected the inaugural group, but future recipients of the Fundamental Physics Prize, to be awarded annually, will be decided by previous winners.

He declined to explain in detail how he selected which accomplishments to honor or why all of the winners are men. “I truly see this as a start,” Mr. Milner said. “Going forward, it’s going to be up to the committee to make those considerations.”

According to the rules, the prize in future years may be split among multiple winners, and a researcher will be able to win more than once. Mr. Milner also announced that there would be a $100,000 prize to honor promising young researchers.

Unlike the Nobel in physics, the Fundamental Physics Prize can be awarded to scientists whose ideas have not yet been verified by experiments, which often occurs decades later. Sometimes a radical new idea “really deserves recognition right away because it expands our understanding of at least what is possible,” Mr. Milner said.

Dr. Arkani-Hamed, for example, has worked on theories about the origin of the Higgs boson, the particle thought to have been discovered recently at the Large Hadron Colliderin Switzerland, and about how that collider could discover new dimensions. None of his theories have been proved yet. He said several were “under strain” because of the new data.

Several of the winners said they hoped that the new prize, with its large cash award, would help raise recognition of physics and draw more students into the field. “It’ll be great to have this sort of showcase for what’s going on in the subject every year,” Dr. Arkani-Hamed said.

The winners said they had not yet decided what to do with their windfall.

“There are some rather mundane things, like paying out the mortgage,” said Mr. Kitaev, who added that he was thinking about putting some of the money into education efforts.

“My success is in large part due to good education, my teachers and the atmosphere of excitement in science when I grew up,” he said. “I might try to help restore this atmosphere as much as I can.”

Dr. Guth agreed. “I do think prizes like this help put across to the public that fundamental physics is important, and it’s not just heavyweight boxing that’s worthy of prizes,” he said.

But he was going to warn his students not to get the wrong idea. “Certainly, it’s still not a great idea to go into physics for the money,” he said.

This article has been revised to reflect the following correction:

Correction: August 1, 2012

 

An article on Tuesday about the new Fundamental Physics Prize misattributed a quotation by a winner about how he would spend the $3 million in prize money. It was Alexei Kitaev, a professor of physics at the California Institute of Technology — not Maxim Kontsevich, a mathematician at the Institute of Advanced Scientific Studies outside Paris who is among the eight other prizewinners — who said, in part, “There are some rather mundane things, like paying out the mortgage.” The article also gave an outdated amount for the monetary award to winners of the Nobel Prize. The prize was reduced this year to about $1.2 million, from about $1.5 million.

 

A version of this article appeared in print on July 31, 2012, on page A7 of the New York edition with the headline: 9 Scientists Receive a New Physics Prize.

By 

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What Is Dysgraphia?

Nirupama Surubhotla
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What Is Dysgraphia?

By: National Center for Learning Disabilities (NCLD) (2006)

Dysgraphia is a learning disability that affects writing abilities. It can manifest itself as difficulties with spelling, poor handwriting and trouble putting thoughts on paper. Because writing requires a complex set of motor and information processing skills, saying a student has dysgraphia is not sufficient. A student with disorders in written expression will benefit from specific accommodations in the learning environment, as well as additional practice learning the skills required to be an accomplished writer.

What are the warning signs of dysgraphia?

Just having bad handwriting doesn’t mean a person has dysgraphia. Since dysgraphia is a processing disorder, difficulties can change throughout a lifetime. However since writing is a developmental process -children learn the motor skills needed to write, while learning the thinking skills needed to communicate on paper – difficulties can also overlap.

If a person has trouble in any of the areas below, additional help may be beneficial.

  • Tight, awkward pencil grip and body position
  • Illegible handwriting
  • Avoiding writing or drawing tasks
  • Tiring quickly while writing
  • Saying words out loud while writing
  • Unfinished or omitted words in sentences
  • Difficulty organizing thoughts on paper
  • Difficulty with syntax structure and grammar
  • Large gap between written ideas and understanding demonstrated through speech.

What strategies can help?

There are many ways to help a person with dysgraphia achieve success. Generally strategies fall into three categories:

Each type of strategy should be considered when planning instruction and support. A person with dysgraphia will benefit from help from both specialists and those who are closest to the person. Finding the most beneficial type of support is a process of trying different ideas and openly exchanging thoughts on what works best.

Early Writers

Below are some examples of how to teach individuals with dysgraphia to overcome some of their difficulties with written expression.

  • Use paper with raised lines for a sensory guide to staying within the lines.
  • Try different pens and pencils to find one that’s most comfortable.
  • Practice writing letters and numbers in the air with big arm movements to improve motor memory of these important shapes. Also practice letters and numbers with smaller hand or finger motions.
  • Encourage proper grip, posture and paper positioning for writing. It’s important to reinforce this early as it’s difficult for students to unlearn bad habits later on.
  • Use multi-sensory techniques for learning letters, shapes and numbers. For example, speaking through motor sequences, such as “b” is “big stick down, circle away from my body.”
  • Introduce a word processor on a computer early; however do not eliminate handwriting for the child. While typing can make it easier to write by alleviating the frustration of forming letters, handwriting is a vital part of a person’s ability to function in the world.
  • Be patient and positive, encourage practice and praise effort – becoming a good writer takes time and practice.

Young Students

  • Allow use of print or cursive – whichever is more comfortable.
  • Use large graph paper for math calculation to keep columns and rows organized.
  • Allow extra time for writing assignments.
  • Begin writing assignments creatively with drawing, or speaking ideas into a tape recorder
  • Alternate focus of writing assignments – put the emphasis on some for neatness and spelling, others for grammar or organization of ideas.
  • Explicitly teach different types of writing – expository and personal essays, short stories, poems, etc.
  • Do not judge timed assignments on neatness and spelling.
  • Have students proofread work after a delay – it’s easier to see mistakes after a break.
  • Help students create a checklist for editing work – spelling, neatness, grammar, syntax, clear progression of ideas, etc.
  • Encourage use of a spell checker – speaking spell checkers are available for handwritten work
  • Reduce amount of copying; instead, focus on writing original answers and ideas
  • Have student complete tasks in small steps instead of all at once.
  • Find alternative means of assessing knowledge, such as oral reports or visual projects
  • Encourage practice through low-stress opportunities for writing such as letters, a diary, making household lists or keeping track of sports teams.

Teenagers & Adults

  • Provide tape recorders to supplement note taking and to prepare for writing assignments.
  • Create a step-by-step plan that breaks writing assignments into small tasks (see below).
  • When organizing writing projects, create a list of keywords that will be useful.
  • Provide clear, constructive feedback on the quality of work, explaining both the strengths and weaknesses of the project, commenting on the structure as well as the information that is included.
  • Use assistive technology such as voice-activated software if the mechanical aspects of writing remain a major hurdle.

Many of these tips can be used by all age groups. It is never too early or too late to reinforce the skills needed to be a good writer.

Though teachers and employers are required by law to make “reasonable accommodations” for individuals with learning disabilities, they may not be aware of how to help. Speak to them about dysgraphia, and explain the challenges you face as a result of your learning disability.

How to approach writing assignments

  • Plan your paper (Pull together your ideas and consider how you want them in your writing.)
  • Organize your thoughts and ideas
  • Create an outline or graphic organizer to be sure you’ve included all your ideas.
  • Make a list of key thoughts and words you will want to use in your paper.

Write a draft

This first draft should focus on getting your ideas on paper — don’t worry about making spelling or grammar errors. Using a computer is helpful because it will be easier to edit later on.

Edit your work

  • Check your work for proper spelling, grammar and syntax; use a spell checker if necessary.
  • Edit your paper to elaborate and enhance content – a thesaurus is helpful for finding different ways to make your point.

Revise your work, producing a final draft

  • Rewrite your work into a final draft.
  • Be sure to read it one last time before submitting it.

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Women’s Preventive Services: Required Health Plan Coverage Guidelines

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Women’s Preventive Services: Required Health Plan Coverage Guidelines

Affordable Care Act Expands Prevention Coverage for Women’s Health and Well-Being

The Affordable Care Act – the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 – helps make prevention affordable and accessible for all Americans by requiring health plans to cover preventive services and by eliminating cost sharing. Preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider.

Women’s Preventive Services: Required Health Plan Coverage Guidelines Supported by the Health Resources and Services Administration

Under the Affordable Care Act, women’s preventive health care – such as mammograms, screenings for cervical cancer, prenatal care, and other services – is covered with no cost sharing for new health plans. However, the law recognizes and HHS understands the need to take into account the unique health needs of women throughout their lifespan.

The HRSA-supported health plan coverage guidelines, developed by the Institute of Medicine (IOM), will help ensure that women receive a comprehensive set of preventive services without having to pay a co-payment, co-insurance or a deductible.  HHS commissioned an IOM study to review what preventive services are necessary for women’s health and well-being and should be considered in the development of comprehensive guidelines for preventive services for women.  HRSA is supporting the IOM’s recommendations on preventive services that address health needs specific to women and fill gaps in existing guidelines.

Health Resources and Services Administration Supported Women’s Preventive Services: Required Health Plan Coverage Guidelines

Non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012.

 

Type of Preventive Service HHS Guideline for Health Insurance Coverage Frequency
Well-woman visits. Well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care. This well-woman visit should, where appropriate,  include other preventive services listed in this set of guidelines, as well as others referenced in section 2713. Annual, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs, and other risk factors.* (see note)
Screening for gestational diabetes. Screening for gestational diabetes. In pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.
Human papillomavirus testing. High-risk human papillomavirus DNA testing in women with normal cytology results. Screening should begin at 30 years of age and should occur no more frequently than every 3 years.
Counseling for sexually transmitted infections. Counseling on sexually transmitted infections for all sexually active women. Annual.
Counseling and screening for human immune-deficiency virus. Counseling and screening for human immune-deficiency virus infection for all sexually active women. Annual.
Contraceptive methods and counseling. ** (see note) All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity. As prescribed.
Breastfeeding support, supplies, and counseling. Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment. In conjunction with each birth.
Screening and counseling for interpersonal and domestic violence. Screening and counseling for interpersonal and domestic violence. Annual.

* Refer to recommendations listed in the July 2011 IOM report entitled Clinical Preventive Services for Women: Closing the Gaps concerning individual preventive services that may be obtained during a well-woman preventive service visit.

** Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.  A religious employer is one that:  (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization under Internal Revenue Code section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii).  45 C.F.R. §147.130(a)(1)(iv)(B). See the Federal Register Notice: Group Health Plans and Health
Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act (PDF – 201 KB)

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The Smartest Person In the World Refuses To Be Trapped By Fate

Nirupama Surubhotla
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by Lisa Kremer

Stephen Hawking called his guest spot on ‘Star Trek: The Next Generation’ fun but ‘not to be taken seriously.’ Picture of Stephen HawkingWorld-famous physicist Stephen Hawking sat slack in his wheelchair Thursday, using finger controls to nimbly move to face each questioner.

He squeezed his hand almost imperceptibly, quickly picking words on a computer screen and building sentences that answered questions from students and fans:

-Being called a genius is “embarrassing.”

-Guest-starring on “Star Trek: The Next Generation” was “great fun but not to be taken seriously.”

-“Nowadays, muscle power is obsolete. Machines can provide that. What we need is mind power, and disabled people are as good at that as anyone else.”

Hawking, 51, gained fame in 1988 with the publication of “A Brief History of Time.” The book later was made into a movie of the same name. He holds the professorship at Cambridge University once held by Sir Isaac Newton and did ground-breaking research on the theory of black holes.

Rather than lecture on theories of astro-physics, the Cambridge University professor gave a glimpse of the day-to-day realities of his life – a life with ALS, or Lou Gehrig’s disease. The disease has cost him his voice and the ability to move all but a few muscles.

For the audience at Seattle University, the glimpse into his personal life was appreciated. More that 24 disabled students, along with parents, friends and reporters, gathered for two hours with Hawking before he lectured to a sold-out crowd downtown.

Students Aleysa Reed, Mitch Weddle, Waikin Chiu, and Anna Schneider enjoy Hawking’s address Thursday at Seattle University. Picture of DO-IT Scholars listening to Stephen Hawking “An inspiration to me is what he is,” said Mitch Weddle, a 16-year-old Spokane resident who wants to study genetics. Weddle watched Hawking from a cot where he lay in a brace, recovering form spine surgery.

A California programmer designed the computer Hawking uses. His hand curled around a small flat black pad, which he squeezed. On a screen facing him, Hawking picked out words and built sentences and then chose an icon that instructed the synthesizer to vocalize the sentence.

“One’s voice is very important,” he said in the synthesizer’s metallic tones. “If you have a slurred voice, people are likely to treat you as mentally deficient.”

Hawking said he likes the synthesizer because it gives his sentences inflection.

“The only trouble is, it gives me an American accent,” he said.

Using the synthesizer, Hawking spoke about how he became aware he had ALS. As the disease progressively ravaged his body, Hawking made adjustments to his life that were more and more intrusive.

The ALS – amyotrophic lateral sclerosis – killed nerves in his brain and spinal cord that control muscles. That led to weakness and paralysis.

In the earlier stages of the disease, he couldn’t walk far, so he needed an apartment near the Cambridge campus. Finding a convenient flat was difficult, he said, and university administrators were uncooperative.

A few years and some productive research later, Hawking’s disease had progressed to the point that he couldn’t negotiate stairs. People were more helpful finding a better flat then, he said.

He needed more and more assistance, from helpful students and then part-time nurses and finally full-time nursing care.

Then, after a bout with pneumonia in 1985, Hawking had a tracheotomy. He couldn’t speak and could communicate only by raising his eyebrows.

At a speed of about 15 words a minute, Hawking carefully answered the students’ questions.

Several asked how Hawking coped with the depression that sometimes accompanies severe disabilities.

“I was a bit depressed,” Hawking said, “but I soon realized that the rest of the world won’t want to know if you are bitter or angry. You have to be positive if you are to get much sympathy or help.”

Another student asked what Hawking thinks of the Americans with Disabilities Act.

Hawking spent several minutes choosing his words as the audience murmured to each other. Then his synthesizer came to life.

“I think disabled people need all the help they can get,” he said. “It is far too easy for companies to discriminate against the disabled like they used to discriminate on grounds of race or sex. I just wish we had similar laws in Britain.”

Kevin Berg, a freshman at Seattle Pacific University, asked, “How does it feel to be labeled the smartest person in the world?”

Hawking rapidly picked out words. He spelled out “media” and “hype,” which were not included in his computer’s library of 3,000 words.

“It is very embarrassing,” was his response. “It is rubbish, just media hype. They just want a hero, and I fill the role model of a disabled genius. At least, I am disabled, but I am no genius.”

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Top 10 states with highest rates of e-prescribing

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Top 10 states with highest rates of e-prescribing

Top 10 states with highest rates of e-prescribing
1.     Minnesota*
2.     Massachusetts
3.     South Dakota
4.     Delaware
5.     New Hampshire*
6.     Iowa
7.     North Carolina
8.     Maine
9.     Vermont*
10.   Michigan

*New to the top 10

“In Minnesota, there has been a strong commitment to a common e-prescribing objective by providers, pharmacies and payers statewide who worked collaboratively with the e-Health Initiative,” said Marty LaVenture, MD, director of the office of health information technology and e-health at the Minnesota Department of Health. “We have benefited from the strategic use of assessment data that helped us identify and respond to the gaps and needs associated with e-prescribing.  Policy initiatives and grant and loan programs also helped increase adoption and use for providers and pharmacies in underserved areas of the state.”

LaVenture is this year’s recipient of the prestigious Safe-Rx Evangelist Award, which is given annually to the person or organization whose work has made an extraordinary impact on the awareness and use of e-prescribing as a critical means of reducing medication errors.

The Safe-Rx Awards celebrate leadership and exceptional commitment to advancing health care safety, efficiency and quality through the use of e-prescribing. They reflect Surescripts’ long-standing collaboration with the nation’s pharmacies, payers, physicians and technology vendors to support the exchange of health information over a network that is non-commercial, neutral, transparent and standards-based. The awards are based on a ranking that measures states’ actual use of e-prescribing.

What About My State?
Rankings aside, e-prescribing use grew substantially across all states in the country in 2011. To view reports detailing the growth of e-prescribing adoption and use in all 50 states plus Washington, D.C. View the reports here.

Surescripts prepared the Safe-Rx Awards Reports using e-prescribing data sets that did not include any protected health information (PHI).

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Minnesota No. 1 e-prescriber, knocks Massachusetts to No. 2

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Minnesota No. 1 e-prescriber, knocks Massachusetts to No. 2

ARLINGTON, VA – Minnesota achieved the highest rate of e-prescribing use in the nation during 2011 to capture the No. 1 ranking in Surescripts’ 7th annual Safe-Rx Awards.

The rankings are determined by an analysis of data that measures electronic prescribing use by physicians, pharmacies and payers in each state, according to Surescipts officials. Adoption and use statistics for all states and an online discussion of the Safe-Rx rankings are available atsurescripts.com/saferx.

“Minnesota has made impressive gains in the adoption and use of all three components of e-prescribing,” said Harry Totonis, president and CEO of Surescripts. “This is helping healthcare providers improve workflows and patient care, and sets the stage for expanding the use of electronic data for additional improvements in healthcare quality and delivery. Congratulations to all Safe-Rx Award winners and to the health care providers and policy makers in the states for taking action to improve one of the most important parts of our nation’s health care system.”

Growth in the adoption and use of e-prescribing – which includes prescription routing, utilization of benefit information and utilization of medication history – created the greatest number of changes in the rankings over its seven-year history. This e-prescribing growth correlates with trends first identified in Surescripts 2011 National Progress Report released May 17, 2012.

IS THIS STORY RELEVANT TO YOU?

 

[See also: Study: e-prescribing not immune from common mistakes.]

The data indicates that state and federal initiatives to increase the adoption and use of e-prescribing by healthcare providers as a means to improve quality, efficiency and help lower costs are significant drivers in e-prescribing’s growth.

Highlights from the 7th Annual Safe-Rx Awards and state progress reports:

  • Prescribers in Minnesota routed 61 percent of prescriptions electronically.
  • Massachusetts and New Hampshire have the highest rate of physician adoption at 86 percent.
  • Nine states have more than 70 percent of physicians electronically routing prescriptions.
  • North Dakota made the largest gains year over year, boosting its ranking from No. 47 to No, 18.
  • New Hampshire, Nebraska and Minnesota all made double-digit gains in the ranking based on increased use of e-prescribing which includes: routing, medication history and benefit information.
  • Nationally, 91 percent of retail pharmacies are able to receive e-prescriptions.

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Sick from stress? Blame your mom and epigenetics

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Sick from stress? Blame your mom and epigenetics

If you’re sick from stress, a new research reportappearing in the August 2012 issue of The FASEBJournal suggests that what your mother ate—or didn’t eat—may be part of the cause. The report shows that choline intake that is higher than what is generally recommended during pregnancy may improve how a child responds to stress. These improvements are the result of epigenetic changes that ultimately lead to lower cortisol levels. Epigenetic changes affect how a gene functions, even if the gene itself is not changed. Lowering cortisol is important as high levels of cortisol are linked to a wide range of problems ranging from mental health to metabolic and cardiovascular disorders.

“We hope that our data will inform the development of choline intake recommendations for pregnant women that ensure optimal fetal development and reduce the risk of stress-related diseases throughout the life of the child,” said Marie A. Caudill, Ph.D., a researcher involved in the work from the Division of Nutritional Sciences and Genomics at Cornell University in Ithaca, New York.

To make this discovery, Caudill and colleagues conducted a 12-week study involving pregnant women in their third trimester who consumed either the control diet providing 480 mg choline per day, a level that approximates current dietary recommendations, or the treatment diet which provided 930 mg choline per day. Maternal blood, cord blood and placenta tissue were collected to measure the blood levels of cortisol, the expression levels of genes that regulate cortisol, and the number of methyl groups attached to the DNA of the cortisol regulating genes (the epigenetic changes). Those from mothers who consumed the higher levels of choline showed reduced levels of cortisol.

“Depending on the relationship, one’s mother can either produce stress or relieve it,” said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. “This report shows that her effect on stress begins even before birth. The importance of choline cannot be overstated as we continue to unravel the role it plays in human health and development.”

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Xinyin Jiang, Jian Yan, Allyson A. West, Cydne A. Perry, Olga V. Malysheva, Srisatish Devapatla, Eva Pressman, Francoise Vermeylen, and Marie A. Caudill. Maternal choline intake alters the epigenetic state of fetal cortisol-regulating genes in humans. FASEB J. doi:10.1096/fj.12-207894; http://www.fasebj.org/content/26/8/3563.abstract

Federation of American Societies for Experimental Biology: http://www.faseb.org

Thanks to Federation of American Societies for Experimental Biology for this article.

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